Healthy adults under the age of 75 are unlikely to benefit from getting more than the daily intake of vitamin D recommended by the Institutes of Medicine (IOM) and do not need screening for vitamin D levels, according to a new Clinical Practice Guideline issued today from the Endocrine Society. For children, pregnant women, adults over 75, and adults with high-risk prediabetes, the guideline recommends vitamin D higher than the IOM’s recommended daily intake.
Vitamin D use and vitamin D blood levels have been associated with many common diseases. However, whether vitamin D supplementation reduces the risk of these diseases and what levels of vitamin D in the blood are needed for optimal health have been debated for years.
In this new guideline, the expert panel established guidelines for the use of vitamin D and the monitoring of vitamin D levels in healthy individuals without established indications for treatment or vitamin D testing. The guideline was based on clinical trials to develop of the recommendations.
The guideline, titled “Vitamin D for Disease Prevention: Endocrine Society Clinical Practice Guidelines” published online and will appear in its August 2024 print issue The Journal of Clinical Endocrinology & Metabolism (JCEM)a publication of the Endocrine Society.
The goal of this guideline was to address vitamin D requirements for disease prevention in a generally healthy population without underlying conditions that would put them at risk for impaired vitamin D absorption or action.”
Marie Demay, MD, of Harvard Medical School and Massachusetts General Hospital in Boston, Massachusetts.
Demay is the chair of the committee that developed the guideline. “Healthy populations that may benefit from higher doses of vitamin D supplementation are those 75 and older, pregnant women, adults with prediabetes, and children and adolescents 18 years and younger, but we do not recommend routine testing of vitamin D levels in any of these groups. “
Key recommendations from the guideline include:
- We recommend against vitamin D supplementation at doses beyond the dietary reference intakes recommended by the IOM in healthy adults under 75 years of age.
- We have identified the following populations that may benefit from dietary supplementation above IOM recommended doses due to the potential to reduce specific health risks:
- Children and adolescents 18 years and younger can prevent nutritional rickets and reduce the chance of respiratory infections.
- People 75 years and older-?potentially for a lower risk of mortality.
- Pregnant – Potential to reduce risk of preeclampsia, intrauterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality.
- People with pre-diabetes – possibility of reducing the progression to diabetes.
- In adults aged 50 years and older who have an indication for vitamin D supplementation or therapy, we recommend a daily, lower dose of vitamin D rather than a non-daily, higher dose of vitamin D.
- We recommend not routinely testing 25-hydroxyvitamin D levels in any of the populations studied, as no outcome-specific benefits based on these levels have been identified. This includes screening for 25-hydroxyvitamin D in people with dark skin or obesity.
Although evidence on the role of vitamin D in health and disease has grown over the past decade, the team noted several limitations in the available evidence. For example, many of the large clinical trials were not designed for many of the outcomes they reported, and the populations studied had vitamin D blood levels that most would consider adequate to begin with. Based on insufficient evidence, the team was unable to determine specific blood level thresholds for 25-hydroxyvitamin D for sufficiency or target levels for disease prevention.
Other members of the Endocrine Society writing committee that developed this guideline include: Anastasios Pittas (co-chair) of Tufts Medical Center in Boston, Massachusetts; Daniel Bikle of the University of California, San Francisco in San Francisco, California. Dima Diab of the University of Cincinnati in Cincinnati, Ohio. Mairead Kiely of University College Cork in Cork, Ireland. Marise Lazaretti-Castro of the Universidade Federal de Sao Paulo in Sao Paulo, Brazil. Paul Lips of the University of Amsterdam Medical Center in Amsterdam, the Netherlands. Deborah Mitchell of Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts. M. Hassan Murad of the Mayo Clinic in Rochester, Minn. Shelley Powers of American Bone Health in Raleigh, NC; Sudhaker Rao of Henry Ford Health in Detroit, Mich. and Michigan State University in Lansing, Mich. Robert Scragg of the University of Auckland in Auckland, New Zealand. John Tayek of Harbor-University of California Los Angeles Medical Center in Torrance, California. Amy Valent of Oregon Health & Science University in Portland, Ore. Judith Walsh of the University of California San Francisco in San Francisco, California. and Christopher McCartney of the University of Virginia in Charlottesville, Va., and West Virginia University in Morgantown, W.Va.
The guideline was developed using a rigorous methodology incorporating numerous refinements that began in 2019. Individuals who lead guideline development panels must not have relevant conflicts of interest, and more than half of the writing team must be free of any relevant conflicts.
The Society created the Clinical Practice Guidelines Program to provide endocrinologists and other clinicians with evidence-based recommendations for the diagnosis, treatment, and management of conditions related to the endocrine system. Each guideline is developed by a multidisciplinary panel of subject matter experts in the field. Guideline development panels rely on evidence-based literature reviews to develop guideline recommendations. The Endocrine Society does not solicit or accept corporate sponsorship for its guidelines. All Clinical Practice Guidelines are supported entirely by Company funds.
This Clinical Practice Guideline was co-sponsored by the American Association of Clinical Endocrinologists, the European Society of Endocrinology, the Pediatric Endocrinology Society, the American Society for Bone and Metal Research, the Vitamin D Laboratory, the American Society for Nutrition, the Brazilian Society of Endocrinology and Metabolism, of the Society of General Internal Medicine and the Endocrine Society of India.
